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Should We Return to the Move from EMR to EHR?

Posted on April 8, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Over the 10 years I’ve been blogging about EMR/EHR, it’s been amazing to watch the evolution of the terms and how people use them. Based on most people’s usage, I’ve long been an advocate that the two terms should and are used interchangably. If you say one or the other, most people are assuming the broadest use of the term. Although, the HITECH Act’s use of the term EHR has certainly made it more popular and in vogue (even if most doctors I know still call it an EMR).

Semantics aside, now that meaningful use has matured, I believe that healthcare is ready for a return to the conceptual differences between an EMR and an EHR. Conceptually an EHR was a record that included the patient provided data along with the clinic’s data (ie. EMR data). This concept was partially included in meaningful use, but not in a very meaningful way.

What are some patient features that would constitute an “EHR”?

Medical Record Access – Patient access to the EMR data should be a core feature of an EHR. Most EMR/EHR vendors provide this feature and more and more doctors are excited to give their patients digital access to their medical record. However, along with access to the medical record we need to build features that allow the patient to submit corrections to the medical record.

Secure Messaging – Patients are increasingly demanding electronic access to their doctor’s office. This secure messaging is often done through the EHR. Most EMR/EHR software have this as an option, but many doctors are afraid of what this messaging will mean for their workflow. Luckily, more and more doctors are sharing the experience that this type of messaging makes their workflow faster and better. High maintenance patients are going to be high maintenance regardless of options they have available to access you.

Patient Generated Data – This feature is still something that many are trying to figure out. Can they allow patients to submit their own health data to the doctor? If they do, what’s the doctor’s liability for that data? How can/should the doctor use the data that’s being shared with the clinic? There are plenty of questions about how this should be executed, but there are also a lot of opportunities. It’s time we start working through these challenges.

There’s a whole suite of other services that we should look at offering patients as well such as: online appointment scheduling, online patient payment, refill requests, etc etc. However, if we could start with just the above 3 items we could truly start calling our systems an Electronic Health Record and not just an Electronic Medial Record. Regardless of what we call it, I believe these types of features and even more patient focused access are going to be the future wave of what patients will expect from their doctor.

Do We Really Like the JASON Recommendations for Interoperable Health Data?

Posted on August 28, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The health IT community has been abuzz over the past few months about a report released by the Agency for Healthcare Research and Quality. Although the report mostly confirmed thoughts that reformers in the health IT space have been discussing for some time, seeing it aired in an official government capacity was galvanizing. The Office of the National Coordinator has held several forums about the report, known by the acronym JASON, and seems favorably inclined toward its recommendations.

Even though only four months have passed since its publication, we can already get some inkling of how it will fare at the ONC, which is going through major realignment of its own. And to tell the truth, I don’t see much happening with the JASON recommendations. In this article I’ll look at what I see to be its specific goals, and what I’ve heard regarding their implementation:
Read more..

Taking the Anxiety out of Healthcare IT (and Cost of Care)

Posted on March 21, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I’m prone to anxiety when it comes to unexplained aches and pains, though I tend to internalize it in an effort to not come across as a hypochondriac. I’m sure I let my inner, extreme worrier come through just a tad during a recent doctor’s appointment. I was visibly relieved to learn that what I had been quietly fretting about for weeks was in fact quite normal. My relief must have been extremely visible, because my doctor was quick to explain that what patients often consider irregular, doctors treat as run of the mill. What I lose sleep over, they don’t bat an eye at. (If only her practice offered a patient portal with secure email, so that we could correspond about my health at our leisure.)

She then told me of a recent trip to the doctor with her mother, and that she had a newfound appreciation for the patient’s side of the visit as she saw things from her mother’s point of view. It was quite refreshing to hear. I might temper my anxiety before my next appointment by playing this mobile game, should it ever be made available in the app store. According to a recent study published in Clinical Psychological Science, 25 minutes of play reduces levels of stress and anxiety. Researchers are looking to see if the effects are the same with shorter bursts of playtime. It’s got to be a cheaper (and healthier) alternative than a prescription for Xanax, right?

Speaking of healthcare costs, I read with interest the news that not only did Castlight Health’s IPO perform better than expected, but that it also partnering with the Leapfrog Group to analyze hospital survey data. Castlight seems poised for success because it is striving to do what healthcare desperately needs done – to bring transparency to and better understanding of healthcare costs in this country. With the Leapfrog project, it seems they are set on tackling quality, safety and patient satisfaction, too. It would be nice, as a patient, to have one trusted resource to go to for consumer-friendly healthcare information so that we could make smart decisions for our families and ourselves.

It would be interesting for a company like Castlight to combine financial, quality, safety and satisfaction data with a notation as to whether hospitals and physicians use EHRs. I noticed that recent results from the latest NCHS Data Brief from CDC show that 42.8% of physicians in Georgia have EHRs – not significantly different than the national average, according to NCHS survey findings. Only nine states ranked above the national average for EHR usage.

I’m off on a tangent here, but I have to ask, when will all 50 states get above 50%? When will everyone be above the national average? With budgets tightening, hospitals closing, and IT deadlines looming, I have a feeling it will be later rather than sooner – if at all.

What do you think? When will your state reach 100%? How do you relieve stress before a doctor’s visit? Would knowing a physician had competitive prices and secure messaging impact your decision to book an appointment? Please share your thoughts in the comments below.

Survey Takers Show No Love for EMRs

Posted on February 13, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Just in time for Valentine’s Day … in case it hasn’t crossed your device or desk, Modern Economics – a self-described web community for health professionals – recently released the results of a survey that attempted to gauge physicians’ satisfaction with EHRs. Of the nearly 1,000 folks polled, nearly 70% concluded their investment in EHRs had not been worth it. Other stats included:

  • 67% are dissatisfied with system functionality
  • 65% indicated systems resulted in financial losses
  • 45% indicated patient care is worse
  • 69% indicated care coordination has not improved
  • 73% of largest practices would not purchase current system

These numbers certainly reflect what many in the industry have been saying for the last few years, but I find the statistics related to care incredibly high. My friends over at reported that survey takers were “self-selected,” so I have to wonder if the entire field of respondents was skewed to the negative from the beginning.

I came across an interesting tweet exchange about the survey results:





I’m no expert, but I definitely think the horse has left the barn, and that if a more impartial survey were done, we’d find more providers satisfied with EHRs and their impact on patient care.

In Blue Button news, I came across several articles this week announcing that leading pharmacies and retailers have joined the Blue Button movement. According to, these organizations are “committing to work over the next year towards standardizing patient prescription information to fuel the growth of private-sector applications and services that can add value to this basic health information.”

It’s encouraging to see businesses like Walgreens and Kroger – two places I shop at –  pledge to bring more awareness of health data to their customers. Perhaps my next post will shed light on how these businesses will accomplish their Blue Button goals.

EHR Appointment Type’s the Headwaters of Workflow

Posted on January 8, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

It’s a rare EHR that doesn’t include scheduling an appointment’s time and purpose. Usually, there’s a line for the patient, which doctor and an appointment type. Patient and doctor are straight forward, but practices may not take advantage of what appointment type can do for them.

Even having meaningful types can be difficult. One practice I worked with just wanted minutes as appointment types, 15, 30, etc. That took a while to work through, but we finally settled on Initial, Pre Op, etc., which made tracking their work a little more meaningful.

Many EHRs leave the subject at having categories or adding insurance requirements. Other EHRs do more and can save a lot of time and work. Rather than seeing appointment type as a handy pigeonhole for patient types, these see appointment type in a critical workflow role of reserving resources for an encounter.

For example, if you schedule a patient’s annual physical, you’ll need a room and someone to do vitals, weight, etc., and an EKG. If you’re a male doctor with a female patient, you’ll want to have a woman staffer scheduled for part of the exam, too.

Rather than schedule these ad hoc, some systems allow you to define the resources needed for the appointment type and schedule them as needed. Greenway’s PrimeSuite, for example, does this. Here’s how it sets up a new appointment type:

  • Click the + sign under the appointment type tab to add the new appointment type.
  • Once you click on the + sign, enter the appointment type in the yellow box
  • To the right of the appointment type name, click the drop down and pick the duration of the appointment type
  • Enter the abbreviation of the appointment type (this will appear on the schedule screen)
  • In box #2 – Enter the patient instructions for this appointment type. This is a friendly reminder to your staff as to what they need to instruct the patient to bring or do.
  • In box #3 – Pick the color of the appointment which will appear on the schedule screen
  • In box #4 – Select and move to the right which resource/provider/room can see this appointment type
  • In box #5 – Select the visit type – category as to which superbill you will want to pull for this appointment type
  • In box #6 – Enter an alternative appointment type that can be printed on confirmations for the patients. This can be the same as box #1, which is your appointment type
  • Click the Save disc at the top
  • Repeat steps until all of your appointment types are entered into the system.

Greenway’s Box No. 4 lets the user specify the resources that go with this appointment type. The user can assign personnel, equipment, rooms, etc. When selected the system checks for availability and reserves them for the needed times.

Greenway’s PrimeSuite Appointment Type Definition Screen

Many practices will be shopping for a new EHR in the coming year. Their shopping lists would do well to include a robust appointment type. Of course, I encourage anyone who’s in the EHR market to use our free resource, The Selector’s Practice Management category has these two appointment type features:

  • PM50 (895) Appointment Type can reserve resources, for example, room, equipment.
  • PM51 (896) Appointment Type can schedule supporting personnel, such as technicians, aides etc.

Brazen Self Promotion
Recently, I created a new LinkedIn group, EHRUsability. This is the type of issue discussion I hope it will promote. All are welcome.

Secure Text and Email, Smartphone Physicals, and EMR Documentation – Around Healthcare Scene

Posted on April 14, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

There are so many types of mHealth apps and devices out there, it was inevitable that someone would try to have them work together. At TEDMED 2013, Shiv Gaglani and a team of physicians-to-be will be presenting the “smartphone physical.” Are these types of visits closer to becoming a reality than we may have realized?

One of the amazing technologies that have been developed is a smartphone that measures vitals — maybe this will be used in smartphone physicals someday! The Fujitsu Smartphone analyzes subtle changes in blood flow and determines vital signs, all by the user taking their photo with the phone’s camera. It goes to show that you don’t necessarily need fancy equipment to have incredible mHealth technology.

While some are concerned about the safety of email and texting for healthcare communication, it’s becoming a way of the future. Companies such as Physia and docBEAT are working specifically to make email and texts more secure. So which one is better? Both have their pros and cons – texting is quick and to the point, while email can take more time. Which would you rather receive?

Most doctors will agree, the current documentation options that EMRs offer are frustrating. There’s just too much clicking. However, the tide is shifting and it is very possible full keyboards will be needed. And the need for point of care EMR documentation will be more necessary than ever before.

With the current budget proposal by President Obama, EMR vendors might be impacted significantly. The ONC is suggesting that health IT vendors pay up to $1 million in fees. With the upcoming expiration of the ONC’s $2 billion appropriation from ARRA, the agency is needing some new funds. It also would help maintain ONC’s Certified Health IT Product List. Of course, vendors will not be happy to hear this news.

EHR and mHealth Successes and Fails: Around Healthcare Scene

Posted on March 31, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Patients are somewhat taught to fear sharing medical data. While privacy is important, especially when it comes to health, being more willing to share medical data can yield great results. The key is knowing who to share information with, and who to avoid. 

EHR vendors can be tricky when it comes to keeping clients around. Sometimes, they don’t really have a choice because the EHR holds client information “hostage” when the client says they are switching EHRs. However, this is a sneaky tactic, and there are many other ways to keep an EHR client longer — most importantly, providing a great product.

While many aspects of HIT have come to a halt, mHealth continues to flourish. There are many things that other parts of HIT can learn from mHealth’s success. First, mHealth doesn’t focus on every patient at once. Next, it is an unregulated industry. And finally, the projects are marketed directly to consumers and paid for by them as well. 

Are you a hospital leader and curious about what technologies you should be watching out for? Well, the ECRI Institute has compiled a list of technologies they feel executives should be looking at this next year. This list includes Electronic Health Records, mHealth, imaging and surgery, and more. 

When an EHR fails to work correctly, how do physicians deal with it? Researchers have observed clinical workflows to answer just that question. The observations concluded that while there was no correct answer, many use paper to record information. Hopefully, this study will show EHRs where their gaps are, and help them to correct them.

There are so many consumer medical devices out there. What makes one stand out from the best? And which one has the best form factor? Wrist bands or chest straps…hand held or pocket stored? Chime in over at Smart Phone Healthcare.

MyPassport, Transcription Costs, and CDC App — Around Healthcare Scene

Posted on January 20, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Hospital EHR and EMR

Hospitals Beware: EMR Copy and Paste Common

EMR Templates can be helpful, but also makes life harder as well. A recent study found that 82 percent of progress notes by residents had 20 percent or more copied and pasted material. This function is tempting for physicians who need to cut time somewhere, but its something that needs to be watched out for and prevented.

iPad App Helps Patients Understand Inpatient Care Process

In an effort to eliminate confusion that often comes during an inpatient stay, Boston Children’s Hospital has developed an iPad app. The app, called MyPassport, helps patients understand more about what is going on during their stay. It displays photos of doctors and nurses, others involved in care, as well as lab results that have been condensed to patient-friendly terms.


EHR Benefit — Transcription Costs Savings

This is the next part of the EHR benefits series. Many doctors were thrilled to give up their transcription for an EHR in hopes of saving costs. However, some are feeling that their EHR may not be the best solution after all. Because of this, some are wanting to implement transcription services again. So, for some, eliminating transcription may not have saved as much money as some had hoped.

Mixing Physical, Mental Health Data Lowers Readmissions

Physicians aren’t often given access to the psychiatric records of patients they are treating. However, a study by Johns Hopkins found that perhaps they should be. The study showed that a signficant percentage of patients whose physicians had access to both physical and mental health data had a smaller readmission rate than those whose mental health records weren’t available.

Smart Phone Healthcare

CDC Launches New Mobile App

The CDC is getting into mHealth with the recent release of their mobile app. The app has many different features, such as health articles, quizzes, and a news room with information outbreaks or other pertinent information. The app is free and definitely one that should be downloaded if you enjoy hearing about health news.

Google Gets Into Activity Tracking

After the failure of Google Health, Google is making an attempt to get into the activity tracking world. “Google Now” basically turns the phone into a personal tracking device, including for fitness. It isn’t as accurate as some of the more sophisticated tracking devices out there, but it is a lot easier to use because it is embedded into the phone. It may make it easier for people to

Disaster Planning, Horrors of Generic HIT Training, and Snap.MD: Around Healthcare Scene

Posted on November 25, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.


Disaster Planning and HIPAA

Unfortunately, it appears that far too many healthcare providers don’t follow this rule. There aren’t very many that even have an emergency plan in place. However, this will soon need to be remedied. HIPAA security general rules state that not only must a patient’s privacy be protected, but the ePHI is available at all times — even in the case of an emergency. All healthcare providers, regardless of size, will need to implement some kind of disaster planning, regardless of their situation, in order to be in compliance with these regulations.

EMR Add-On’s that Provide Physician Benefit

MedCPU is a part of the inaugural NYC Digitial Health Accelerator class. They have developed a new concept that will likely to very helpful to many. It analyzes free text notes and structured data, and checks for compliance with rules and to identify any deviances. The company described one hospital using the services the company provides as a benefit given to doctors who use EHR. This is just one of many add-ons available, but some are seeing them to be a large reason why some doctors want to adopt EMRs.

Hospital EMR and EHR

Video: The Horrors of Generic HIT Training

Need a break from the day-to-day monotony? Be sure to check at this video on the horrors of generic HIT Training. It “offers a wry take on what happens when EMR training isn’t relevant for the doctor who’s getting the training. In this case, we witness the plight of a heart surgeon who’s forced through a discussion on primary care functions that she neither wants nor needs.”

Study: EMR ROI Stronger In Low-Income Setting

A recent study revealed something interesting. Hospitals in low-income areas actually may have a decent return on investment when an EMR is integrated. Three different areas were looked at and analyzed, and it was found that after five years of having an EMR, the hospital examined had a net benefit of over $600,000. Not all hospitals will benefit this much, but it’s encouraging to see more EMR success stories popping up.

Smart Phone Healthcare

Get Peace of Mind and Avoid the ER With Snap.MD

It’s the middle of the night, and your child breaks out in a rash all of his or her body. The doctor’s office doesn’t have middle of the night, on-call doctors, so the only option is the ER, right? Maybe not for long. Snap.MD, a new telemedicine system, may help parents decide if the Emergency Room is the best course of action. Parents of pediatric patients are connected to physician, who will help evaluate the situation via video conferencing.

Will Meaningful Use Affect M&A In The EMR Space?

Posted on November 19, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As some of you may recall, Allscripts is said to be floating the possibility of selling out to a venture capital firm. This follows several months of tumult at the board level, including some who might have been helpful in keeping its merger with Eclypsis moving forward.

I’ve been thinking about this deal for a while, wondering whether it would come to fruition and if so, what would make it happen. And I’ve realized an Allscripts deal, or other EMR company sale, might give us a window into just how valuable Meaningful Use criteria have proven to be. Let me explain.

If I was a EMR vendor looking for an acquisition or merger, I’d certainly look at the usual metrics, including the customer list, code base my target had in house, maturity of the product line, the extent to which in-house programming talent could support the roadmap and so on. (Naturally, I’d go over its books in depth too.)

But that’s not all. These days we have some new perspectives from which to evaluate the success of EMR vendors, a set of standards which are fairly unique in the software business.  Two important examples: We can look at how successfully a vendor’s customers have been able to meet Meaningful Use goals to date, and how far along the HIMSS EMR Adoption Model customers are as well.

While both are interesting, Meaningful Use is more important, as it’s such a politically fraught, complicated and rapidly evolving set of standards. In short, I’d argue that if a vendor’s customers are doing well with MU, then it’s likely the vendor is doing something right.

Now, you can’t draw a straight line between the quality of a vendor’s product and how well its customers  have done in qualifying  for Meaningful Use. Implementation is ultimately the hospital or doctor’s responsibility, even if the provider pays for EMR vendor consulting to get things going. And there’s lots of ways things can go wrong that have little or nothing to do with the product.

Still, I predict that Meaningful Use success is going to become a more important metric in EMR vendor M&A as time goes by. After all, the more bragging rights a company has regarding Meaningful Use success, the more they can improve the acquiring vendor’s profile. That’s gotta matter.